Purpose: The association of postoperative myocardial infarction with occurrence of arterial or venous coronary graft failure remains unclear. Methodology: Patients underwent predominantly symptom-indicated conventional or coronary CT angiography at the Royal Melbourne Hospital following coronary bypass surgery, with only the most recent angiogram assessed. Patients either received total arterial revascularisation (TAR) with internal mammary artery (IMA) or radial artery (RA) grafts, or they had at least one saphenous vein graft (SVG) with or without concomitant arterial grafts, referred to as non-TAR. The effect of arterial and venous graft failure on incidence of non-fatal non-ST segment elevation myocardial infarction (NSTEMI) was analysed with multivariate binary logistic regression . Results: A total of 979 patients were included in the study, of which 742 (75.8%) received symptom-indicated angiography at 8.9±5.9 years postoperative. Furthermore, 691 patients received TAR with 3.0±1.0 (1-7) arterial grafts, and 288 patients received non-TAR with 1.3±0.6 (1-4) SVG. From 173 TAR patients who had at least one arterial graft failure, 32 (18.5%) presented for angiography with NSTEMI. From 518 TAR patients without arterial graft failure, 100 (19.3%) presented with NSTEMI. Occurrence of arterial graft failure had no effect on the incidence of NSTEMI presentation in TAR patients, hazard ratio (HR)=0.9; (95% confidence interval (CI)=0.6-1.4; p=0.688). From 74 non-TAR patients with at least one SVG failure, 19 (25.7%) presented with NSTEMI. From 214 non-TAR patients without SVG failure, 24 (11.2%) presented with NSTEMI. SVG failure was associated with increased risk of NSTEMI presentation in non-TAR patients, HR=2.9 (95% CI=1.4-6.1; p=0.004). Conclusions: The occurrence of SVG failure presents an increased risk of postoperative NSTEMI. This trend may be explained by a propensity of SVG for late-term failure, whereby ischaemic consequences are thought more prevalent.